Presentation of Claim Form

Use our convenient online claim form in the event of loss or damage of cargo or freight.

Indicates required Field.

Shipment Information

Freight Bill / AWB Number

Departure Date

Vessel/Voy or Flight #

Container (ocean only)

Claimant Information

Company Name

Name of Person Filing Claim

Address

City

State

Zip

Email

Phone

Fax

Statement of Claim

Reason for claim

Shortage
Damage
Other

Amount of Claim

Explain in detail how you determined the claim amount. List the number and description of the goods, the nature and extent of loss or damage, the invoice cost and the amount of your claim. The claim must list at least one Description and Claim Amount.

Currency

U.S. Dollars
CDN Dollars

Total Claim Amount:

Description

Amount

Description

Amount

Description

Amount

Description

Amount

Description

Amount

Description

Amount

Comments

Supporting Documents

Correspondence supporting a claim such as shipper’s invoice, repair invoice (if applicable), proof of delivery, inspection, etc., must be faxed to 310.537.1400 or mailed to 19201 Susana Rd, Rancho Dominguez, CA 90221, to the attention of the Claims Department. Without supporting documents we are unable to begin process of a claim and will be unable to consider your claim for payment.

Important! Original Vendor Invoice is REQUIRED. All other document(s) are optional.

Please check off the documents included with this claim:

Original Vendor Invoice

Copy of Bill of Lading

Copy of Paid Freight Bill

Consignee Copy of Delivery Receipt (Proof of Delivery)

Inspection Report, select type of report:

ShipperCarrierConsignee

Original Repair Invoice

Other

WHEN, FOR ANY REASON, THE ORIGINAL PAID FREIGHT BILL OR BILL OF LADING IS NOT PROVIDED, CLAIMANT MUST INDEMNIFY CARRIER OR CARRIERS AGAINST DUPLICATE CLAIMS SUPPORTED BY ORIGINAL DOCUMENTS

INDEMNITY AGREEMENT

When the original bill of lading and/or freight bill is not submitted, or is not available for submission, but copies of the original are submitted in support of the claim described above, the claimant agrees to indemnify and hold harmless the carrier receiving this claim, named above, and any participating carriers, and will pay to the carrier or any participating carrier all losses, costs, damages, counsel fees or any other expenses it (the carrier) may incur resulting from all lawful subsequent duplicate claims arising out of the same shipment which may be filed and supported by the original documents.